Help for people with mental health and substance use issues has become more accessible now that the Georgia Crisis & Access Line launched a mobile app. The aim of the My GCAL app is to guide people to free and confidential access, and the targets are those who would rather send a text message than speak to someone over the phone. In Georgia and elsewhere, this tends to be younger people. “We are trying to be proactive,” said Georgia Gov. Brian Kemp. “We need kids to know that it’s okay to text if you need help. We have to remove that stigma.” Atlanta Journal-Constitution.

maewjpho/Thinkstock

Ninth-grade students at the Uplift Hampton Preparatory school in Dallas have been taking part in classroom sessions where role-playing activities are helping them spot the signs of depression in themselves and others. “It’s kind of like ‘Mental Health 101,’ ” said Tony Walker, senior director of student support services at Uplift Education, in an Associated Press article published in the National Post. “So they talk about depression and anxiety and just common mental health issues, and then I think the most important thing is they talk about what to do if you feel that way.” The Youth Aware of Mental Health (YAM) program, administered by Madhukar H. Trivedi, MD, of the University of Texas Southwestern Medical Center is offered to all 9th-graders in the 20-school Uplift Education network in the Dallas area. The program, consisting of five 45-minute sessions, originally was developed at the Karolinska Institute in Stockholm and Columbia University in New York. A similar initiative offered by the National Alliance on Mental Illness (NAMI) teaches students the warning signs of mental health problems. Since the NAMI program launched in 2014, it has reached almost 450,000 youth in 41 states. National Post.

Identifying the source of students’ frustration and anger can prevent them from lashing out, according to a National Public Radio report. But responses rooted in compassion can help diffuse potentially tragic outcomes. The report describes the story of a young man whose struggles started in middle school. An encounter with bullies left him with severe damage in his right eye, and he spent his high school years getting into fights. After school officials stepped in, acknowledged that he had reasons to be angry, and connected him with a mentor who was able to talk and reason with him, the young man graduated on time. He’s now 25 and works full time for a security firm. “Moving kids from despair to hope. That’s the bumper sticker for what we do,” said school psychologist John Van Dreal. The approach “really works,” he added. NPR.

An exhibition now running at the Science Center of Iowa in Des Moines is helping patrons explore the reality of mental illness. The Mental Health: Mind Matters exhibition is intended to show the real lives of people with mental illness, with the hope of inspiring better appreciation and empathy. It features audio renderings of what the world can sound like to someone with psychosis, walk-through rooms that take patrons inside the homes of people with depression, and exercises that inspire worry or fear, as well as photography. The aim is to take the patron inside the heads of those with mental illnesses. “A possibility now exists to utilize a constellation of exhibits like Mind Matters to revolutionize understanding, prevention, and wellness nationally, all while unlocking economic benefits and advancing human dignity,” wrote Paul Piwko, the author of an article describing the exhibit. Des Moines Register.

Students are creating a dialogue about suicide awareness and prevention at Gardner (Kansas) Edgerton High School. At a recent basketball game with Shawnee Mission West High School, Gardner Edgerton team members, students, cheerleaders, and fans donned T-shirts emblazoned with “#ZeroReasonsWhy.” The student-led campaign is aimed at encouraging students to seek help rather than consider suicide. At the game, T-shirts and bracelets also were handed out to Shawnee Mission West players in an effort to spread the message. The Kansas City Star.

Help for people with mental health and substance use issues has become more accessible now that the Georgia Crisis & Access Line launched a mobile app. The aim of the My GCAL app is to guide people to free and confidential access, and the targets are those who would rather send a text message than speak to someone over the phone. In Georgia and elsewhere, this tends to be younger people. “We are trying to be proactive,” said Georgia Gov. Brian Kemp. “We need kids to know that it’s okay to text if you need help. We have to remove that stigma.” Atlanta Journal-Constitution.

maewjpho/Thinkstock

Ninth-grade students at the Uplift Hampton Preparatory school in Dallas have been taking part in classroom sessions where role-playing activities are helping them spot the signs of depression in themselves and others. “It’s kind of like ‘Mental Health 101,’ ” said Tony Walker, senior director of student support services at Uplift Education, in an Associated Press article published in the National Post. “So they talk about depression and anxiety and just common mental health issues, and then I think the most important thing is they talk about what to do if you feel that way.” The Youth Aware of Mental Health (YAM) program, administered by Madhukar H. Trivedi, MD, of the University of Texas Southwestern Medical Center is offered to all 9th-graders in the 20-school Uplift Education network in the Dallas area. The program, consisting of five 45-minute sessions, originally was developed at the Karolinska Institute in Stockholm and Columbia University in New York. A similar initiative offered by the National Alliance on Mental Illness (NAMI) teaches students the warning signs of mental health problems. Since the NAMI program launched in 2014, it has reached almost 450,000 youth in 41 states. National Post.

Identifying the source of students’ frustration and anger can prevent them from lashing out, according to a National Public Radio report. But responses rooted in compassion can help diffuse potentially tragic outcomes. The report describes the story of a young man whose struggles started in middle school. An encounter with bullies left him with severe damage in his right eye, and he spent his high school years getting into fights. After school officials stepped in, acknowledged that he had reasons to be angry, and connected him with a mentor who was able to talk and reason with him, the young man graduated on time. He’s now 25 and works full time for a security firm. “Moving kids from despair to hope. That’s the bumper sticker for what we do,” said school psychologist John Van Dreal. The approach “really works,” he added. NPR.

An exhibition now running at the Science Center of Iowa in Des Moines is helping patrons explore the reality of mental illness. The Mental Health: Mind Matters exhibition is intended to show the real lives of people with mental illness, with the hope of inspiring better appreciation and empathy. It features audio renderings of what the world can sound like to someone with psychosis, walk-through rooms that take patrons inside the homes of people with depression, and exercises that inspire worry or fear, as well as photography. The aim is to take the patron inside the heads of those with mental illnesses. “A possibility now exists to utilize a constellation of exhibits like Mind Matters to revolutionize understanding, prevention, and wellness nationally, all while unlocking economic benefits and advancing human dignity,” wrote Paul Piwko, the author of an article describing the exhibit. Des Moines Register.

Students are creating a dialogue about suicide awareness and prevention at Gardner (Kansas) Edgerton High School. At a recent basketball game with Shawnee Mission West High School, Gardner Edgerton team members, students, cheerleaders, and fans donned T-shirts emblazoned with “#ZeroReasonsWhy.” The student-led campaign is aimed at encouraging students to seek help rather than consider suicide. At the game, T-shirts and bracelets also were handed out to Shawnee Mission West players in an effort to spread the message. The Kansas City Star.

Help for people with mental health and substance use issues has become more accessible now that the Georgia Crisis & Access Line launched a mobile app. The aim of the My GCAL app is to guide people to free and confidential access, and the targets are those who would rather send a text message than speak to someone over the phone. In Georgia and elsewhere, this tends to be younger people. “We are trying to be proactive,” said Georgia Gov. Brian Kemp. “We need kids to know that it’s okay to text if you need help. We have to remove that stigma.” Atlanta Journal-Constitution.

maewjpho/Thinkstock

Ninth-grade students at the Uplift Hampton Preparatory school in Dallas have been taking part in classroom sessions where role-playing activities are helping them spot the signs of depression in themselves and others. “It’s kind of like ‘Mental Health 101,’ ” said Tony Walker, senior director of student support services at Uplift Education, in an Associated Press article published in the National Post. “So they talk about depression and anxiety and just common mental health issues, and then I think the most important thing is they talk about what to do if you feel that way.” The Youth Aware of Mental Health (YAM) program, administered by Madhukar H. Trivedi, MD, of the University of Texas Southwestern Medical Center is offered to all 9th-graders in the 20-school Uplift Education network in the Dallas area. The program, consisting of five 45-minute sessions, originally was developed at the Karolinska Institute in Stockholm and Columbia University in New York. A similar initiative offered by the National Alliance on Mental Illness (NAMI) teaches students the warning signs of mental health problems. Since the NAMI program launched in 2014, it has reached almost 450,000 youth in 41 states. National Post.

Identifying the source of students’ frustration and anger can prevent them from lashing out, according to a National Public Radio report. But responses rooted in compassion can help diffuse potentially tragic outcomes. The report describes the story of a young man whose struggles started in middle school. An encounter with bullies left him with severe damage in his right eye, and he spent his high school years getting into fights. After school officials stepped in, acknowledged that he had reasons to be angry, and connected him with a mentor who was able to talk and reason with him, the young man graduated on time. He’s now 25 and works full time for a security firm. “Moving kids from despair to hope. That’s the bumper sticker for what we do,” said school psychologist John Van Dreal. The approach “really works,” he added. NPR.

An exhibition now running at the Science Center of Iowa in Des Moines is helping patrons explore the reality of mental illness. The Mental Health: Mind Matters exhibition is intended to show the real lives of people with mental illness, with the hope of inspiring better appreciation and empathy. It features audio renderings of what the world can sound like to someone with psychosis, walk-through rooms that take patrons inside the homes of people with depression, and exercises that inspire worry or fear, as well as photography. The aim is to take the patron inside the heads of those with mental illnesses. “A possibility now exists to utilize a constellation of exhibits like Mind Matters to revolutionize understanding, prevention, and wellness nationally, all while unlocking economic benefits and advancing human dignity,” wrote Paul Piwko, the author of an article describing the exhibit. Des Moines Register.

Students are creating a dialogue about suicide awareness and prevention at Gardner (Kansas) Edgerton High School. At a recent basketball game with Shawnee Mission West High School, Gardner Edgerton team members, students, cheerleaders, and fans donned T-shirts emblazoned with “#ZeroReasonsWhy.” The student-led campaign is aimed at encouraging students to seek help rather than consider suicide. At the game, T-shirts and bracelets also were handed out to Shawnee Mission West players in an effort to spread the message. The Kansas City Star.

A previously uncharacterized variant of endocervical mucinous adenocarcinoma, gastric-type mucinous carcinoma, was found to be linked with histopathological markers of poor clinical outcomes, including reduced survival and resistance to therapy, according to a retrospective histopathological study.

“[Gastric-type mucinous carcinoma] constitutes a unique tumor type with distinct etiologic, morphologic, and clinical features that set it apart from other mucinous carcinomas,” Shin Nishio, MD, PhD, of Kurume (Japan) University and his colleagues wrote in Gynecologic Oncology.

The researchers retrospectively analyzed 393 women with stage I or II endocervical adenocarcinoma who received surgical treatment without concomitant chemotherapy. Sample slides were collected from of all patients with endocervical adenocarcinoma and were compared for variations in clinicopathological features between disease subtypes.

Dr. Nishio and his colleagues performed histopathological analysis on both usual-type endocervical adenocarcinoma and gastric-type mucinous carcinoma.

“The outcomes in patients with each type of disease were statistically compared,” they wrote.

Multivariable analysis showed that, compared with usual-type endocervical adenocarcinoma, gastric-type mucinous carcinoma was associated with worse clinical outcomes, including more aggressive tumor behavior, resistance to radio- and chemotherapy, and reduced progression-free and overall survival.

“Our study clearly shows that recurrence was more common among patients with GAS [gastric-type endocervical adenocarcinoma],” they added.

The authors acknowledged that further research is needed to fully understand the molecular mechanisms of various forms of endocervical adenocarcinoma.

“The profiles of the genomic signatures of unusual cervical cancers are still limited, and definitive treatment guidelines for such cancers remain to be established,” they concluded.

The study was funded by the National Cancer Center Research and Development Fund of Japan. The authors reported no conflicts of interest.

SOURCE: Nishio S et al. Gynecol Oncol. 2019 Jan 29. doi: 10.1016/j.ygyno.2019.01.022.

A previously uncharacterized variant of endocervical mucinous adenocarcinoma, gastric-type mucinous carcinoma, was found to be linked with histopathological markers of poor clinical outcomes, including reduced survival and resistance to therapy, according to a retrospective histopathological study.

“[Gastric-type mucinous carcinoma] constitutes a unique tumor type with distinct etiologic, morphologic, and clinical features that set it apart from other mucinous carcinomas,” Shin Nishio, MD, PhD, of Kurume (Japan) University and his colleagues wrote in Gynecologic Oncology.

The researchers retrospectively analyzed 393 women with stage I or II endocervical adenocarcinoma who received surgical treatment without concomitant chemotherapy. Sample slides were collected from of all patients with endocervical adenocarcinoma and were compared for variations in clinicopathological features between disease subtypes.

Dr. Nishio and his colleagues performed histopathological analysis on both usual-type endocervical adenocarcinoma and gastric-type mucinous carcinoma.

“The outcomes in patients with each type of disease were statistically compared,” they wrote.

Multivariable analysis showed that, compared with usual-type endocervical adenocarcinoma, gastric-type mucinous carcinoma was associated with worse clinical outcomes, including more aggressive tumor behavior, resistance to radio- and chemotherapy, and reduced progression-free and overall survival.

“Our study clearly shows that recurrence was more common among patients with GAS [gastric-type endocervical adenocarcinoma],” they added.

The authors acknowledged that further research is needed to fully understand the molecular mechanisms of various forms of endocervical adenocarcinoma.

“The profiles of the genomic signatures of unusual cervical cancers are still limited, and definitive treatment guidelines for such cancers remain to be established,” they concluded.

The study was funded by the National Cancer Center Research and Development Fund of Japan. The authors reported no conflicts of interest.

SOURCE: Nishio S et al. Gynecol Oncol. 2019 Jan 29. doi: 10.1016/j.ygyno.2019.01.022.

A previously uncharacterized variant of endocervical mucinous adenocarcinoma, gastric-type mucinous carcinoma, was found to be linked with histopathological markers of poor clinical outcomes, including reduced survival and resistance to therapy, according to a retrospective histopathological study.

“[Gastric-type mucinous carcinoma] constitutes a unique tumor type with distinct etiologic, morphologic, and clinical features that set it apart from other mucinous carcinomas,” Shin Nishio, MD, PhD, of Kurume (Japan) University and his colleagues wrote in Gynecologic Oncology.

The researchers retrospectively analyzed 393 women with stage I or II endocervical adenocarcinoma who received surgical treatment without concomitant chemotherapy. Sample slides were collected from of all patients with endocervical adenocarcinoma and were compared for variations in clinicopathological features between disease subtypes.

Dr. Nishio and his colleagues performed histopathological analysis on both usual-type endocervical adenocarcinoma and gastric-type mucinous carcinoma.

“The outcomes in patients with each type of disease were statistically compared,” they wrote.

Multivariable analysis showed that, compared with usual-type endocervical adenocarcinoma, gastric-type mucinous carcinoma was associated with worse clinical outcomes, including more aggressive tumor behavior, resistance to radio- and chemotherapy, and reduced progression-free and overall survival.

“Our study clearly shows that recurrence was more common among patients with GAS [gastric-type endocervical adenocarcinoma],” they added.

The authors acknowledged that further research is needed to fully understand the molecular mechanisms of various forms of endocervical adenocarcinoma.

“The profiles of the genomic signatures of unusual cervical cancers are still limited, and definitive treatment guidelines for such cancers remain to be established,” they concluded.

The study was funded by the National Cancer Center Research and Development Fund of Japan. The authors reported no conflicts of interest.

SOURCE: Nishio S et al. Gynecol Oncol. 2019 Jan 29. doi: 10.1016/j.ygyno.2019.01.022.

Correct Answer: E 
 
Rationale  
This patient has slow-transit constipation without concomitant defecatory disorder, which is unresponsive to newer pharmacologic agents. According to the recently published AGA medical position paper on constipation, the next step in this patient's evaluation should be to repeat colon transit testing on medications. If abnormal, the next step would be evaluation for possible upper GI motility disorder including a gastric-emptying scan. There is no role for repeat anorectal manometry, balloon expulsion testing, or a trial of biofeedback therapy in this patient. 
 
References  
1. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-57.  
2. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218. 
 
ginews@gastro.org

Correct Answer: E 
 
Rationale  
This patient has slow-transit constipation without concomitant defecatory disorder, which is unresponsive to newer pharmacologic agents. According to the recently published AGA medical position paper on constipation, the next step in this patient's evaluation should be to repeat colon transit testing on medications. If abnormal, the next step would be evaluation for possible upper GI motility disorder including a gastric-emptying scan. There is no role for repeat anorectal manometry, balloon expulsion testing, or a trial of biofeedback therapy in this patient. 
 
References  
1. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-57.  
2. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218. 
 
ginews@gastro.org

Correct Answer: E 
 
Rationale  
This patient has slow-transit constipation without concomitant defecatory disorder, which is unresponsive to newer pharmacologic agents. According to the recently published AGA medical position paper on constipation, the next step in this patient's evaluation should be to repeat colon transit testing on medications. If abnormal, the next step would be evaluation for possible upper GI motility disorder including a gastric-emptying scan. There is no role for repeat anorectal manometry, balloon expulsion testing, or a trial of biofeedback therapy in this patient. 
 
References  
1. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-57.  
2. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218. 
 
ginews@gastro.org

Correct Answer: B 
 
Rationale 
The ultrasound finding of a hyperechoic protrusion is suggestive of a gallbladder polyp. These polyps can have malignant potential and should be monitored or referred for surgical management depending on their size. There is consensus that polyps larger than 10 mm should be referred for cholecystectomy. There is some debate about whether polyps greater than 6 mm should also be referred for surgery or whether they can be surveyed. For gallbladder polyps less than 6 mm, surveillance with ultrasound in 6-12 months is the recommended surveillance strategy. 
 
Reference 
1. Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am. 2010;39(2):359-67.

Correct Answer: B 
 
Rationale 
The ultrasound finding of a hyperechoic protrusion is suggestive of a gallbladder polyp. These polyps can have malignant potential and should be monitored or referred for surgical management depending on their size. There is consensus that polyps larger than 10 mm should be referred for cholecystectomy. There is some debate about whether polyps greater than 6 mm should also be referred for surgery or whether they can be surveyed. For gallbladder polyps less than 6 mm, surveillance with ultrasound in 6-12 months is the recommended surveillance strategy. 
 
Reference 
1. Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am. 2010;39(2):359-67.

Correct Answer: B 
 
Rationale 
The ultrasound finding of a hyperechoic protrusion is suggestive of a gallbladder polyp. These polyps can have malignant potential and should be monitored or referred for surgical management depending on their size. There is consensus that polyps larger than 10 mm should be referred for cholecystectomy. There is some debate about whether polyps greater than 6 mm should also be referred for surgery or whether they can be surveyed. For gallbladder polyps less than 6 mm, surveillance with ultrasound in 6-12 months is the recommended surveillance strategy. 
 
Reference 
1. Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am. 2010;39(2):359-67.

Does my breath smell like reduced cancer risk?

Cancer prevention just got a whole lot more ... fragrant. Allium vegetables – garlic, onions, leeks, chives, and shallots – have been found to decrease the risk of colorectal cancer (CRC), according to a Chinese study published last year. Very good news for Italians, but it looks like the risk of CRC in the vampire population might continue to rise.

Olga Guchek/iStock / Getty Images Plus

The study authors reported that high allium intake correlated with lower CRC risk in both men and women, in the northeast Chinese population sampled. Bioactive compounds in these vegetables have anticarcinogenic properties, and researchers found that eating at least 35 pounds of allium vegetables per year could reduce cancer risk.

Unclear if this study was secretly funded by Big Onion, but as fans of delicious and anticancer flavor, we here at LOTME support these findings. However, we strongly advise against going the Tony Abbott route of chomping into whole onions.
 

An IPA a day keeps the doctor away

After you’re finished eating your annual 35 pounds of garlic and onions (sure, do it all in 1 day if you want), you might be a little thirsty. And we’ve got good news for you – have a brewski, it’s good for ya! Turns out, hops might have some health benefits, so drink up.

coldsnowstorm/iStock / Getty Images Plus

Hops contain a class of compound called isohumulones, which gives them that bitter taste. There have been multiple studies showing the metabolic effects of isohumulones, including cell inflammation suppression, reduced weight gain, reduced hyperglycemia, and increased glucose tolerance.

These isohumulones (try typing that 10 times in a row) interact with the bitter taste receptors in the gut, and researchers are hopeful that this could lead to isohumulone-esque drugs to treat metabolic disorders. In the meantime, maybe just chug a few IPAs a day.
 

My kingdom for a helmet

Most people like to root for the underdog. You know, the whole David vs. Goliath thing, the little guy who goes against overwhelming odds to take on some form of the Big Establishment.

Marcus Lindstrom/iStock /Getty Images Plus

But what if the little guy happens to be a fairly normal-sized lacrosse player with a very large head?

Alex Chu, a freshman at Division III Wheaton College in Norton, Mass., is just such a guy. “My head is wide,” he told WJAR TV. He wants to play goalie for the school’s lacrosse team, but he can’t because no current helmet will fit on the 25-inch-circumference head that sits atop his 6-foot-tall, 265-pound body.

He’s up against Big Sports Equipment in the form of Cascade-Maverik and Warrior, the two major manufacturers of lacrosse helmets, which won’t build him a custom helmet. It would be too expensive, they say – but the Boston Globe reported that there is a lacrosse player at a Division I school who wears a very large helmet “that was produced after [his] coaches and Cascade ‘huddled up.’ ”

We wish Mr. Chu well, and perhaps one day he will be mentioned with such large-skulled high achievers as Jay Leno, LeBron James, Jennifer Garner, Tyrannosaurus rex, Rihanna, Napoleon Bonaparte, SpongeBob SquarePants, and Simon Cowell.
 

We’ll just have the salad

Zombies, beware: You might want to eat us, but now, we can eat you.

Whiteway/Getty Images

Okay, “zombie” deer aren’t actually zombies, but they are infected with something almost as terrifying. Chronic wasting disease is a prion disorder similar to bovine spongiform encephalopathy, or mad cow disease, and has been found in deer across 24 U.S. states as of January 2019.

While venison is less commonly eaten than beef, if mad cow disease can make the jump to humans, can people who eat meat infected with chronic wasting disease also become infected?

Thanks to an Oneida County, N.Y., fire company and a 2005 Sportsmen’s feast we’re sure someone’s never heard the end of, we know the answer to be “no.”

The fire company accidentally served meat from a deer that was infected with chronic wasting disease, and more than 200 people were exposed. A group of about 80 of these individuals have been monitored since then by a research team from the Oneida County Health Department and the State University of New York at Binghamton. At the most recent follow-up, no individual had developed the disease.

Experts do caution that it’s entirely possible chronic wasting disease will make the jump to humans eventually, despite the species gap. But for now, you can enjoy without fear your sweet ironic revenge on those zombies.
 

Does my breath smell like reduced cancer risk?

Cancer prevention just got a whole lot more ... fragrant. Allium vegetables – garlic, onions, leeks, chives, and shallots – have been found to decrease the risk of colorectal cancer (CRC), according to a Chinese study published last year. Very good news for Italians, but it looks like the risk of CRC in the vampire population might continue to rise.

Olga Guchek/iStock / Getty Images Plus

The study authors reported that high allium intake correlated with lower CRC risk in both men and women, in the northeast Chinese population sampled. Bioactive compounds in these vegetables have anticarcinogenic properties, and researchers found that eating at least 35 pounds of allium vegetables per year could reduce cancer risk.

Unclear if this study was secretly funded by Big Onion, but as fans of delicious and anticancer flavor, we here at LOTME support these findings. However, we strongly advise against going the Tony Abbott route of chomping into whole onions.
 

An IPA a day keeps the doctor away

After you’re finished eating your annual 35 pounds of garlic and onions (sure, do it all in 1 day if you want), you might be a little thirsty. And we’ve got good news for you – have a brewski, it’s good for ya! Turns out, hops might have some health benefits, so drink up.

coldsnowstorm/iStock / Getty Images Plus

Hops contain a class of compound called isohumulones, which gives them that bitter taste. There have been multiple studies showing the metabolic effects of isohumulones, including cell inflammation suppression, reduced weight gain, reduced hyperglycemia, and increased glucose tolerance.

These isohumulones (try typing that 10 times in a row) interact with the bitter taste receptors in the gut, and researchers are hopeful that this could lead to isohumulone-esque drugs to treat metabolic disorders. In the meantime, maybe just chug a few IPAs a day.
 

My kingdom for a helmet

Most people like to root for the underdog. You know, the whole David vs. Goliath thing, the little guy who goes against overwhelming odds to take on some form of the Big Establishment.

Marcus Lindstrom/iStock /Getty Images Plus

But what if the little guy happens to be a fairly normal-sized lacrosse player with a very large head?

Alex Chu, a freshman at Division III Wheaton College in Norton, Mass., is just such a guy. “My head is wide,” he told WJAR TV. He wants to play goalie for the school’s lacrosse team, but he can’t because no current helmet will fit on the 25-inch-circumference head that sits atop his 6-foot-tall, 265-pound body.

He’s up against Big Sports Equipment in the form of Cascade-Maverik and Warrior, the two major manufacturers of lacrosse helmets, which won’t build him a custom helmet. It would be too expensive, they say – but the Boston Globe reported that there is a lacrosse player at a Division I school who wears a very large helmet “that was produced after [his] coaches and Cascade ‘huddled up.’ ”

We wish Mr. Chu well, and perhaps one day he will be mentioned with such large-skulled high achievers as Jay Leno, LeBron James, Jennifer Garner, Tyrannosaurus rex, Rihanna, Napoleon Bonaparte, SpongeBob SquarePants, and Simon Cowell.
 

We’ll just have the salad

Zombies, beware: You might want to eat us, but now, we can eat you.

Whiteway/Getty Images

Okay, “zombie” deer aren’t actually zombies, but they are infected with something almost as terrifying. Chronic wasting disease is a prion disorder similar to bovine spongiform encephalopathy, or mad cow disease, and has been found in deer across 24 U.S. states as of January 2019.

While venison is less commonly eaten than beef, if mad cow disease can make the jump to humans, can people who eat meat infected with chronic wasting disease also become infected?

Thanks to an Oneida County, N.Y., fire company and a 2005 Sportsmen’s feast we’re sure someone’s never heard the end of, we know the answer to be “no.”

The fire company accidentally served meat from a deer that was infected with chronic wasting disease, and more than 200 people were exposed. A group of about 80 of these individuals have been monitored since then by a research team from the Oneida County Health Department and the State University of New York at Binghamton. At the most recent follow-up, no individual had developed the disease.

Experts do caution that it’s entirely possible chronic wasting disease will make the jump to humans eventually, despite the species gap. But for now, you can enjoy without fear your sweet ironic revenge on those zombies.
 

Does my breath smell like reduced cancer risk?

Cancer prevention just got a whole lot more ... fragrant. Allium vegetables – garlic, onions, leeks, chives, and shallots – have been found to decrease the risk of colorectal cancer (CRC), according to a Chinese study published last year. Very good news for Italians, but it looks like the risk of CRC in the vampire population might continue to rise.

Olga Guchek/iStock / Getty Images Plus

The study authors reported that high allium intake correlated with lower CRC risk in both men and women, in the northeast Chinese population sampled. Bioactive compounds in these vegetables have anticarcinogenic properties, and researchers found that eating at least 35 pounds of allium vegetables per year could reduce cancer risk.

Unclear if this study was secretly funded by Big Onion, but as fans of delicious and anticancer flavor, we here at LOTME support these findings. However, we strongly advise against going the Tony Abbott route of chomping into whole onions.
 

An IPA a day keeps the doctor away

After you’re finished eating your annual 35 pounds of garlic and onions (sure, do it all in 1 day if you want), you might be a little thirsty. And we’ve got good news for you – have a brewski, it’s good for ya! Turns out, hops might have some health benefits, so drink up.

coldsnowstorm/iStock / Getty Images Plus

Hops contain a class of compound called isohumulones, which gives them that bitter taste. There have been multiple studies showing the metabolic effects of isohumulones, including cell inflammation suppression, reduced weight gain, reduced hyperglycemia, and increased glucose tolerance.

These isohumulones (try typing that 10 times in a row) interact with the bitter taste receptors in the gut, and researchers are hopeful that this could lead to isohumulone-esque drugs to treat metabolic disorders. In the meantime, maybe just chug a few IPAs a day.
 

My kingdom for a helmet

Most people like to root for the underdog. You know, the whole David vs. Goliath thing, the little guy who goes against overwhelming odds to take on some form of the Big Establishment.

Marcus Lindstrom/iStock /Getty Images Plus

But what if the little guy happens to be a fairly normal-sized lacrosse player with a very large head?

Alex Chu, a freshman at Division III Wheaton College in Norton, Mass., is just such a guy. “My head is wide,” he told WJAR TV. He wants to play goalie for the school’s lacrosse team, but he can’t because no current helmet will fit on the 25-inch-circumference head that sits atop his 6-foot-tall, 265-pound body.

He’s up against Big Sports Equipment in the form of Cascade-Maverik and Warrior, the two major manufacturers of lacrosse helmets, which won’t build him a custom helmet. It would be too expensive, they say – but the Boston Globe reported that there is a lacrosse player at a Division I school who wears a very large helmet “that was produced after [his] coaches and Cascade ‘huddled up.’ ”

We wish Mr. Chu well, and perhaps one day he will be mentioned with such large-skulled high achievers as Jay Leno, LeBron James, Jennifer Garner, Tyrannosaurus rex, Rihanna, Napoleon Bonaparte, SpongeBob SquarePants, and Simon Cowell.
 

We’ll just have the salad

Zombies, beware: You might want to eat us, but now, we can eat you.

Whiteway/Getty Images

Okay, “zombie” deer aren’t actually zombies, but they are infected with something almost as terrifying. Chronic wasting disease is a prion disorder similar to bovine spongiform encephalopathy, or mad cow disease, and has been found in deer across 24 U.S. states as of January 2019.

While venison is less commonly eaten than beef, if mad cow disease can make the jump to humans, can people who eat meat infected with chronic wasting disease also become infected?

Thanks to an Oneida County, N.Y., fire company and a 2005 Sportsmen’s feast we’re sure someone’s never heard the end of, we know the answer to be “no.”

The fire company accidentally served meat from a deer that was infected with chronic wasting disease, and more than 200 people were exposed. A group of about 80 of these individuals have been monitored since then by a research team from the Oneida County Health Department and the State University of New York at Binghamton. At the most recent follow-up, no individual had developed the disease.

Experts do caution that it’s entirely possible chronic wasting disease will make the jump to humans eventually, despite the species gap. But for now, you can enjoy without fear your sweet ironic revenge on those zombies.
 

The Food and Drug Administration has granted the reformulated BinaxNOW Influenza A & B Card 2 waived status under the Clinical Laboratory Improvements Amendments for use with Abbott’s DIGIVAL reader, which means the system is relatively simple and has a low risk of erroneous results.

According to Abbott’s press release, the DIGIVAL reader (formerly known as the Alere Reader) automatically interprets this rapid influenza diagnostic test’s results in seconds and is intended to remove subjectivity from the diagnostic process. The BinaxNOW Influenza Card A & B Card 2 is a Class II assay and complies with the FDA’s new reclassification requirements for rapid influenza diagnostic tests.

cpalmer@mdedge.com

The Food and Drug Administration has granted the reformulated BinaxNOW Influenza A & B Card 2 waived status under the Clinical Laboratory Improvements Amendments for use with Abbott’s DIGIVAL reader, which means the system is relatively simple and has a low risk of erroneous results.

According to Abbott’s press release, the DIGIVAL reader (formerly known as the Alere Reader) automatically interprets this rapid influenza diagnostic test’s results in seconds and is intended to remove subjectivity from the diagnostic process. The BinaxNOW Influenza Card A & B Card 2 is a Class II assay and complies with the FDA’s new reclassification requirements for rapid influenza diagnostic tests.

cpalmer@mdedge.com

The Food and Drug Administration has granted the reformulated BinaxNOW Influenza A & B Card 2 waived status under the Clinical Laboratory Improvements Amendments for use with Abbott’s DIGIVAL reader, which means the system is relatively simple and has a low risk of erroneous results.

According to Abbott’s press release, the DIGIVAL reader (formerly known as the Alere Reader) automatically interprets this rapid influenza diagnostic test’s results in seconds and is intended to remove subjectivity from the diagnostic process. The BinaxNOW Influenza Card A & B Card 2 is a Class II assay and complies with the FDA’s new reclassification requirements for rapid influenza diagnostic tests.

cpalmer@mdedge.com

Introducing the Multiple Sclerosis Resource Center Editor-in-Chief, Joseph R. Berger, M.D., FACP, FAAN, FANA.

Dr. Berger is Professor of Neurology and  Associate Chief of the Multiple Sclerosis Division of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is a fellow of the American College of Physicians, American Academy of Neurology and the American Neurological Association. He has published more than 240 refereed papers, more than 100 chapters, and has co-edited three textbooks.  Dr. Berger co-founded and chaired the first international conference on the neurological complications of HIV, the Neuroscience of HIV meeting.  He also established the Commonwealth Neurological Society for neurologists in the state of Kentucky. Dr. Berger has a longstanding interest in international health and was one of the founding members of People-to-People, an organization for HIV/AIDS care and education in East Africa.

Introducing the Multiple Sclerosis Resource Center Editor-in-Chief, Joseph R. Berger, M.D., FACP, FAAN, FANA.

Dr. Berger is Professor of Neurology and  Associate Chief of the Multiple Sclerosis Division of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is a fellow of the American College of Physicians, American Academy of Neurology and the American Neurological Association. He has published more than 240 refereed papers, more than 100 chapters, and has co-edited three textbooks.  Dr. Berger co-founded and chaired the first international conference on the neurological complications of HIV, the Neuroscience of HIV meeting.  He also established the Commonwealth Neurological Society for neurologists in the state of Kentucky. Dr. Berger has a longstanding interest in international health and was one of the founding members of People-to-People, an organization for HIV/AIDS care and education in East Africa.

Introducing the Multiple Sclerosis Resource Center Editor-in-Chief, Joseph R. Berger, M.D., FACP, FAAN, FANA.

Dr. Berger is Professor of Neurology and  Associate Chief of the Multiple Sclerosis Division of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is a fellow of the American College of Physicians, American Academy of Neurology and the American Neurological Association. He has published more than 240 refereed papers, more than 100 chapters, and has co-edited three textbooks.  Dr. Berger co-founded and chaired the first international conference on the neurological complications of HIV, the Neuroscience of HIV meeting.  He also established the Commonwealth Neurological Society for neurologists in the state of Kentucky. Dr. Berger has a longstanding interest in international health and was one of the founding members of People-to-People, an organization for HIV/AIDS care and education in East Africa.

Click here to read supplement. 

Gene therapy is a contemporary therapeutic intervention with recent positive results and regulatory approvals either completed or expected in the next several years for various con­ditions. In this supplement, learn more about:

• Basic principles of gene therapy
• In vivo vs ex vivo methods of gene transfer
• Vector types
• Clinical Considerations

About the Author

Click here to read supplement. 

Click here to read supplement. 

Gene therapy is a contemporary therapeutic intervention with recent positive results and regulatory approvals either completed or expected in the next several years for various con­ditions. In this supplement, learn more about:

• Basic principles of gene therapy
• In vivo vs ex vivo methods of gene transfer
• Vector types
• Clinical Considerations

About the Author

Click here to read supplement. 

Click here to read supplement. 

Gene therapy is a contemporary therapeutic intervention with recent positive results and regulatory approvals either completed or expected in the next several years for various con­ditions. In this supplement, learn more about:

• Basic principles of gene therapy
• In vivo vs ex vivo methods of gene transfer
• Vector types
• Clinical Considerations

About the Author

Click here to read supplement. 

When this 45-year-old man was in third grade, he began to notice areas of hair loss in his scalp. The affected area was always round and the hair loss complete—but it would grow back entirely within weeks to months. There was never any rash or discomfort associated with these changes.

Since then, he has experienced numerous similar episodes of focal hair loss, sometimes in the beard, sometimes on the arms or legs, and most recently, in his eyebrows. Again, no symptoms accompany the process.

Although his personal health history is relatively uneventful, his family has not been as fortunate. There are numerous cases of lupus, rheumatoid arthritis, diabetes, and thyroid disease.

EXAMINATION
There are sharply defined, crescent-shaped, 2.5-cm divots at the superior borders of both eyebrows in which every hair is gone. No redness, swelling, or scaling are seen or felt, and there is no detectable adenopathy in the region.

Examination of hair-bearing regions reveals no other areas of hair loss.

What’s the diagnosis?

DISCUSSION
This case illustrates several variants of an extremely common condition: alopecia areata (AA), literally translated as “hair loss confined to a particular localized area or areas.” Although AA is more common in adults, it often affects children. And though the scalp is by far the most commonly affected area, AA can cause hair loss anywhere on the body.

In general, the earlier the onset, the more likely the problem is to become recurrent or even progressive. In rare instances, a patient can develop alopecia totalis, in which there is permanent and total scalp hair loss, or even alopecia universalis, the permanent loss of every hair on the entire body. Other predictors of a poor prognosis include extensive involvement of the scalp, especially the periphery (termed ophiasis), and a history of atopy.

Much research has been done on the underlying pathology of AA, as well as potential remedies. This has proven, beyond any doubt, that the problem is autoimmune and tends to run in families (as with other autoimmune diseases), suggesting a hereditary basis. We also know that medications that dampen this autoimmune process, such as steroids and biologics, are useful but not always safe or practical.

What we don’t really know is what triggers an actual attack. My observation, based on 35 years of dermatology practice, is that stress often plays a part—but I’d be hard pressed to prove that, and it wouldn’t be very useful even if I could. This patient adamantly agreed that stress was the trigger for his AA.

The differential for AA includes tinea capitis, discoid lupus, and lichen planopilaris. This patient’s multiple episodes over decades made the correct diagnosis clear. However, when the diagnosis is in doubt—other items in the differential commonly affect the scalp, although they may also manifest with redness, scaling, or swelling—a punch biopsy may be necessary to sort through the possibilities. Care must be taken to enter the skin parallel to hair follicles when the sample is removed.

Many treatments have been tried for AA, but none are reliably effective. In the vast majority of patients, the problem resolves itself. Treatments to try when needed include topical steroids, intralesional steroids, and topical immune stimulators (eg, squaric acid or dinitrochlorobenzene)—all of which have their limitations.

TAKE-HOME LEARNING POINTS

• Alopecia areata (AA) is more common in adults but can affect children as well.
• In rare cases, the patient can experience permanent total hair loss on the scalp (alopecia totalis) or the entire body (alopecia universalis).
• Because AA is an autoimmune disease, steroids and biologics may be useful treatments—but they are not always safe or practical.
• In a majority of patients with AA, the problem will resolve on its own.

When this 45-year-old man was in third grade, he began to notice areas of hair loss in his scalp. The affected area was always round and the hair loss complete—but it would grow back entirely within weeks to months. There was never any rash or discomfort associated with these changes.

Since then, he has experienced numerous similar episodes of focal hair loss, sometimes in the beard, sometimes on the arms or legs, and most recently, in his eyebrows. Again, no symptoms accompany the process.

Although his personal health history is relatively uneventful, his family has not been as fortunate. There are numerous cases of lupus, rheumatoid arthritis, diabetes, and thyroid disease.

EXAMINATION
There are sharply defined, crescent-shaped, 2.5-cm divots at the superior borders of both eyebrows in which every hair is gone. No redness, swelling, or scaling are seen or felt, and there is no detectable adenopathy in the region.

Examination of hair-bearing regions reveals no other areas of hair loss.

What’s the diagnosis?

DISCUSSION
This case illustrates several variants of an extremely common condition: alopecia areata (AA), literally translated as “hair loss confined to a particular localized area or areas.” Although AA is more common in adults, it often affects children. And though the scalp is by far the most commonly affected area, AA can cause hair loss anywhere on the body.

In general, the earlier the onset, the more likely the problem is to become recurrent or even progressive. In rare instances, a patient can develop alopecia totalis, in which there is permanent and total scalp hair loss, or even alopecia universalis, the permanent loss of every hair on the entire body. Other predictors of a poor prognosis include extensive involvement of the scalp, especially the periphery (termed ophiasis), and a history of atopy.

Much research has been done on the underlying pathology of AA, as well as potential remedies. This has proven, beyond any doubt, that the problem is autoimmune and tends to run in families (as with other autoimmune diseases), suggesting a hereditary basis. We also know that medications that dampen this autoimmune process, such as steroids and biologics, are useful but not always safe or practical.

What we don’t really know is what triggers an actual attack. My observation, based on 35 years of dermatology practice, is that stress often plays a part—but I’d be hard pressed to prove that, and it wouldn’t be very useful even if I could. This patient adamantly agreed that stress was the trigger for his AA.

The differential for AA includes tinea capitis, discoid lupus, and lichen planopilaris. This patient’s multiple episodes over decades made the correct diagnosis clear. However, when the diagnosis is in doubt—other items in the differential commonly affect the scalp, although they may also manifest with redness, scaling, or swelling—a punch biopsy may be necessary to sort through the possibilities. Care must be taken to enter the skin parallel to hair follicles when the sample is removed.

Many treatments have been tried for AA, but none are reliably effective. In the vast majority of patients, the problem resolves itself. Treatments to try when needed include topical steroids, intralesional steroids, and topical immune stimulators (eg, squaric acid or dinitrochlorobenzene)—all of which have their limitations.

TAKE-HOME LEARNING POINTS

• Alopecia areata (AA) is more common in adults but can affect children as well.
• In rare cases, the patient can experience permanent total hair loss on the scalp (alopecia totalis) or the entire body (alopecia universalis).
• Because AA is an autoimmune disease, steroids and biologics may be useful treatments—but they are not always safe or practical.
• In a majority of patients with AA, the problem will resolve on its own.

When this 45-year-old man was in third grade, he began to notice areas of hair loss in his scalp. The affected area was always round and the hair loss complete—but it would grow back entirely within weeks to months. There was never any rash or discomfort associated with these changes.

Since then, he has experienced numerous similar episodes of focal hair loss, sometimes in the beard, sometimes on the arms or legs, and most recently, in his eyebrows. Again, no symptoms accompany the process.

Although his personal health history is relatively uneventful, his family has not been as fortunate. There are numerous cases of lupus, rheumatoid arthritis, diabetes, and thyroid disease.

EXAMINATION
There are sharply defined, crescent-shaped, 2.5-cm divots at the superior borders of both eyebrows in which every hair is gone. No redness, swelling, or scaling are seen or felt, and there is no detectable adenopathy in the region.

Examination of hair-bearing regions reveals no other areas of hair loss.

What’s the diagnosis?

DISCUSSION
This case illustrates several variants of an extremely common condition: alopecia areata (AA), literally translated as “hair loss confined to a particular localized area or areas.” Although AA is more common in adults, it often affects children. And though the scalp is by far the most commonly affected area, AA can cause hair loss anywhere on the body.

In general, the earlier the onset, the more likely the problem is to become recurrent or even progressive. In rare instances, a patient can develop alopecia totalis, in which there is permanent and total scalp hair loss, or even alopecia universalis, the permanent loss of every hair on the entire body. Other predictors of a poor prognosis include extensive involvement of the scalp, especially the periphery (termed ophiasis), and a history of atopy.

Much research has been done on the underlying pathology of AA, as well as potential remedies. This has proven, beyond any doubt, that the problem is autoimmune and tends to run in families (as with other autoimmune diseases), suggesting a hereditary basis. We also know that medications that dampen this autoimmune process, such as steroids and biologics, are useful but not always safe or practical.

What we don’t really know is what triggers an actual attack. My observation, based on 35 years of dermatology practice, is that stress often plays a part—but I’d be hard pressed to prove that, and it wouldn’t be very useful even if I could. This patient adamantly agreed that stress was the trigger for his AA.

The differential for AA includes tinea capitis, discoid lupus, and lichen planopilaris. This patient’s multiple episodes over decades made the correct diagnosis clear. However, when the diagnosis is in doubt—other items in the differential commonly affect the scalp, although they may also manifest with redness, scaling, or swelling—a punch biopsy may be necessary to sort through the possibilities. Care must be taken to enter the skin parallel to hair follicles when the sample is removed.

Many treatments have been tried for AA, but none are reliably effective. In the vast majority of patients, the problem resolves itself. Treatments to try when needed include topical steroids, intralesional steroids, and topical immune stimulators (eg, squaric acid or dinitrochlorobenzene)—all of which have their limitations.

TAKE-HOME LEARNING POINTS

• Alopecia areata (AA) is more common in adults but can affect children as well.
• In rare cases, the patient can experience permanent total hair loss on the scalp (alopecia totalis) or the entire body (alopecia universalis).
• Because AA is an autoimmune disease, steroids and biologics may be useful treatments—but they are not always safe or practical.
• In a majority of patients with AA, the problem will resolve on its own.

Uncomplicated gastroesophageal reflux disease (GERD) accounted for 13.5% of esophagogastroduodenoscopies, but 5.6% of these patients had suspected Barrett’s esophagus and only 1.4% had suspected long-segment Barrett’s esophagus, researchers reported. The study appears in the April issue of Clinical Gastroenterology and Hepatology.

“The prevalence of suspected Barrett’s esophagus is lower than in prior time periods. This raises questions about the utility of esophagogastroduodenoscopies to detect Barrett’s esophagus in patients with uncomplicated GERD,” wrote Emery C. Lin, MD, of Oregon Health and Science University, Portland, and his associates there and at Massachusetts General Hospital, Boston.

Symptoms of GERD affect more than one in four U.S. adults and are a risk factor for Barrett’s esophagus. However, the prevalence of Barrett’s esophagus is unclear in patients with dysphagia and in the era of proton pump inhibitors, the researchers said. The American Gastroenterological Association strongly discourages reflexively screening patients with GERD for Barrett’s esophagus, but “weakly recommends” screening GERD patients with multiple risk factors for Barrett’s esophagus, including chronic GERD, hiatal hernia, older age (50 years and up), white race, male sex, increased body mass index, and intra-abdominal adiposity.

To understand the prevalence and findings of esophagogastroduodenoscopy in patients with GERD without alarm symptoms (including weight loss, dysphagia, and bleeding), the investigators studied 543,103 of these procedures performed at 82 sites in the United States between 2003 and 2013. The data came from the National Endoscopic Database, which generates endoscopy reports using a structured computer form.

A total of 73,535 esophagogastroduodenoscopies (13.5%) were performed for GERD without alarm symptoms. Among these patients, 4,122 (5.6%) had suspected Barrett’s esophagus, of which 24.2% had suspected long-segment Barrett’s esophagus (3 cm or longer). Among patients with uncomplicated GERD, the prevalence of suspected Barrett’s esophagus was 5.6%, and the prevalence of long-segment disease was 1.4%.

Although male sex, older age, and white race were significant risk factors for suspected Barrett’s esophagus and suspected long-segment disease, 23.6% of esophagogastroduodenoscopies were performed in white men older than 50 years. “We find that low-risk populations with uncomplicated GERD make up a significant number of esophagogastroduodenoscopies done for uncomplicated GERD,” the investigators wrote. “If esophagogastroduodenoscopies were limited to patients that met the AGA criteria of being male, white, and age over 50, we would have detected 34 of 47 (72.3%) of esophageal tumors and found suspected Barrett’s esophagus in nearly 10%, while reducing the burden of endoscopy by more than 75%.”

Hiatal hernia was a significant correlate of suspected Barrett’s esophagus (odds ratio, 1.6), the researchers noted. Esophagitis was not associated with suspected Barrett’s esophagus overall but did correlate with long-segment disease. Esophagitis might mask underlying short-segment Barrett’s esophagus, and short-segment Barrett’s esophagus might be milder in nature and more responsive to antisecretory therapy, the researchers said. They noted that severe (grade C/D) esophagitis was strongly linked with both short-segment and long-segment Barrett’s esophagus.

The National Institute of Diabetes and Digestive and Kidney Diseases provided funding. The researchers reported having no conflicts of interest.

SOURCE: Lin EC et al. Clin Gastroenterol Hepatol. 2019 Apr. doi: 10.1016/j.cgh.2018.08.066.

Uncomplicated gastroesophageal reflux disease (GERD) accounted for 13.5% of esophagogastroduodenoscopies, but 5.6% of these patients had suspected Barrett’s esophagus and only 1.4% had suspected long-segment Barrett’s esophagus, researchers reported. The study appears in the April issue of Clinical Gastroenterology and Hepatology.

“The prevalence of suspected Barrett’s esophagus is lower than in prior time periods. This raises questions about the utility of esophagogastroduodenoscopies to detect Barrett’s esophagus in patients with uncomplicated GERD,” wrote Emery C. Lin, MD, of Oregon Health and Science University, Portland, and his associates there and at Massachusetts General Hospital, Boston.

Symptoms of GERD affect more than one in four U.S. adults and are a risk factor for Barrett’s esophagus. However, the prevalence of Barrett’s esophagus is unclear in patients with dysphagia and in the era of proton pump inhibitors, the researchers said. The American Gastroenterological Association strongly discourages reflexively screening patients with GERD for Barrett’s esophagus, but “weakly recommends” screening GERD patients with multiple risk factors for Barrett’s esophagus, including chronic GERD, hiatal hernia, older age (50 years and up), white race, male sex, increased body mass index, and intra-abdominal adiposity.

To understand the prevalence and findings of esophagogastroduodenoscopy in patients with GERD without alarm symptoms (including weight loss, dysphagia, and bleeding), the investigators studied 543,103 of these procedures performed at 82 sites in the United States between 2003 and 2013. The data came from the National Endoscopic Database, which generates endoscopy reports using a structured computer form.

A total of 73,535 esophagogastroduodenoscopies (13.5%) were performed for GERD without alarm symptoms. Among these patients, 4,122 (5.6%) had suspected Barrett’s esophagus, of which 24.2% had suspected long-segment Barrett’s esophagus (3 cm or longer). Among patients with uncomplicated GERD, the prevalence of suspected Barrett’s esophagus was 5.6%, and the prevalence of long-segment disease was 1.4%.

Although male sex, older age, and white race were significant risk factors for suspected Barrett’s esophagus and suspected long-segment disease, 23.6% of esophagogastroduodenoscopies were performed in white men older than 50 years. “We find that low-risk populations with uncomplicated GERD make up a significant number of esophagogastroduodenoscopies done for uncomplicated GERD,” the investigators wrote. “If esophagogastroduodenoscopies were limited to patients that met the AGA criteria of being male, white, and age over 50, we would have detected 34 of 47 (72.3%) of esophageal tumors and found suspected Barrett’s esophagus in nearly 10%, while reducing the burden of endoscopy by more than 75%.”

Hiatal hernia was a significant correlate of suspected Barrett’s esophagus (odds ratio, 1.6), the researchers noted. Esophagitis was not associated with suspected Barrett’s esophagus overall but did correlate with long-segment disease. Esophagitis might mask underlying short-segment Barrett’s esophagus, and short-segment Barrett’s esophagus might be milder in nature and more responsive to antisecretory therapy, the researchers said. They noted that severe (grade C/D) esophagitis was strongly linked with both short-segment and long-segment Barrett’s esophagus.

The National Institute of Diabetes and Digestive and Kidney Diseases provided funding. The researchers reported having no conflicts of interest.

SOURCE: Lin EC et al. Clin Gastroenterol Hepatol. 2019 Apr. doi: 10.1016/j.cgh.2018.08.066.

Uncomplicated gastroesophageal reflux disease (GERD) accounted for 13.5% of esophagogastroduodenoscopies, but 5.6% of these patients had suspected Barrett’s esophagus and only 1.4% had suspected long-segment Barrett’s esophagus, researchers reported. The study appears in the April issue of Clinical Gastroenterology and Hepatology.

“The prevalence of suspected Barrett’s esophagus is lower than in prior time periods. This raises questions about the utility of esophagogastroduodenoscopies to detect Barrett’s esophagus in patients with uncomplicated GERD,” wrote Emery C. Lin, MD, of Oregon Health and Science University, Portland, and his associates there and at Massachusetts General Hospital, Boston.

Symptoms of GERD affect more than one in four U.S. adults and are a risk factor for Barrett’s esophagus. However, the prevalence of Barrett’s esophagus is unclear in patients with dysphagia and in the era of proton pump inhibitors, the researchers said. The American Gastroenterological Association strongly discourages reflexively screening patients with GERD for Barrett’s esophagus, but “weakly recommends” screening GERD patients with multiple risk factors for Barrett’s esophagus, including chronic GERD, hiatal hernia, older age (50 years and up), white race, male sex, increased body mass index, and intra-abdominal adiposity.

To understand the prevalence and findings of esophagogastroduodenoscopy in patients with GERD without alarm symptoms (including weight loss, dysphagia, and bleeding), the investigators studied 543,103 of these procedures performed at 82 sites in the United States between 2003 and 2013. The data came from the National Endoscopic Database, which generates endoscopy reports using a structured computer form.

A total of 73,535 esophagogastroduodenoscopies (13.5%) were performed for GERD without alarm symptoms. Among these patients, 4,122 (5.6%) had suspected Barrett’s esophagus, of which 24.2% had suspected long-segment Barrett’s esophagus (3 cm or longer). Among patients with uncomplicated GERD, the prevalence of suspected Barrett’s esophagus was 5.6%, and the prevalence of long-segment disease was 1.4%.

Although male sex, older age, and white race were significant risk factors for suspected Barrett’s esophagus and suspected long-segment disease, 23.6% of esophagogastroduodenoscopies were performed in white men older than 50 years. “We find that low-risk populations with uncomplicated GERD make up a significant number of esophagogastroduodenoscopies done for uncomplicated GERD,” the investigators wrote. “If esophagogastroduodenoscopies were limited to patients that met the AGA criteria of being male, white, and age over 50, we would have detected 34 of 47 (72.3%) of esophageal tumors and found suspected Barrett’s esophagus in nearly 10%, while reducing the burden of endoscopy by more than 75%.”

Hiatal hernia was a significant correlate of suspected Barrett’s esophagus (odds ratio, 1.6), the researchers noted. Esophagitis was not associated with suspected Barrett’s esophagus overall but did correlate with long-segment disease. Esophagitis might mask underlying short-segment Barrett’s esophagus, and short-segment Barrett’s esophagus might be milder in nature and more responsive to antisecretory therapy, the researchers said. They noted that severe (grade C/D) esophagitis was strongly linked with both short-segment and long-segment Barrett’s esophagus.

The National Institute of Diabetes and Digestive and Kidney Diseases provided funding. The researchers reported having no conflicts of interest.

SOURCE: Lin EC et al. Clin Gastroenterol Hepatol. 2019 Apr. doi: 10.1016/j.cgh.2018.08.066.